Childbirth And Obstetric Techniques

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Contents of this book are based on the available evidence and the years of clinical experience, research and teaching track record of the two authors. The chapter on antenatal care largely concentrates on what the clinician should know at the time of delivery about the normality and the health of the fetus. The good ultrasound images with the line diagrams explain the anomalies. Various abnormalities that may need to be dealt with during or soon after delivery are described. The chapter on the mechanism of childbirth explains the process of interplay between the ‘power, passenger and passage’. The cardinal movements of the fetal presentation to maternal pelvis/pelvic floor are explained. The chapter on management of labor describes the diagnosis and initial assessment followed by fetal surveillance in low- and high-risk labor. Detailed information on electronic fetal monitoring and fetal scalp blood sampling is provided. The use of partogram and induction of labor is described. Chapter 5 deals with normal labor, positions that can be adapted, management of second and third stage and ends in the management of shoulder dystocia. Resuscitation of the newborn is an essential skill for the healthcare provider in the delivery unit and is well-described. The chapter on perineal repair deals with repair of various types of episiotomies and then explains the repair of the second-degree perineal tear. Common problems immediately after delivery are well-handled from minor to major events. It covers details of vulvar hematoma, manual removal of placenta, primary and secondary postpartum hemorrhage, uterine inversion, seizures, pulmonary thromboembolism and amniotic fluid embolism. Operative vaginal delivery is a part of our daily practice and has been dealt with by a clear step-by-step account of vacuum assisted and rotational and nonrotational forceps delivery. External cephalic version in a breech presentation and assisted breech delivery is well-described with photographs for the different techniques used at different stages of the delivery. The art of vaginal twin delivery should be kept alive and the chapter on twins deals with vaginal twin delivery including internal podalic version and breech extraction. Cesarean section is one of the commonest operations faced by about 25% of our mothers in the UK. The technique from skin incision to delivery of the baby, placenta and membranes is well- described and followed by a clear account of the closure techniques. In addition to lower uterine segment cesarean section, lower segment midline, upper midline uterine incisions and ‘En caule’ delivery are described.